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Pancreatitis
Pancreatitis is acute or chronic inflammation of the pancreas. It may be caused by infection, or irritation from the pancreas' own production of digestive enzymes. Pancreatitis, whether chronic or acute, usually requires a lowering of dietary fat levels. What happens in pancreatitis is actually a matter of bad timing; the enzymes responsible for the digestion of food are released prematurely and begin digesting the pancreas, not eaten food. In animals who do not have diabetes, one of the symptoms of pancreatitis can be a temporary or transient hyperglycemia where glucose values can be considered to be abnormally elevated, but are not in the extremely high ranges. Signs While both dogs and cats can suffer from chronic pancreatitis, the species differ when it comes to signs of it. Dogs tend to have repeated acute episodes while cats appear to have gradual inflammation with difficult to pinpoint signs of illness. Having diabetes puts dogs at a greater risk of acute pancreatitis. Vomiting is the major sign of pancreatitis in dogs; if there's been several vomiting episodes over a 12 hour period, pancreatitis should be suspected. Why pancreatitis can be serious Acute pancreatitis can trigger a buildup of fluid, particularly in abdominal and thoractic areas, acute renal failure, and cause inflammation in arteries and veins. The inflammation triggers the body's clotting factors, possibly depleting them to the point of spontaneous bleeding. Concurrent with Diabetes There is evidence to suggest that chronic, subclinical (unable to be ascertained through present testing methods) pancreatitis is common in canines with diabetes. A study conducted by Drs. Fleeman and Rand puts the estimate of canine diabetics with pancreatitis--either acute or chronic at about 40%. Dr. Fleeman also states that it is chronic pancreatitis and the damage it causes to the organ that is responsible for 1/3 of canine diabetes cases; Dr. Greco echoes this thought. This 2000 lecture given at the District of Columbia Academy of Veterinary Medicine regarding managing acute pancreatitis in dogs and cats refers to an (uncited) study suggesting that cats with pancreatitis are quite sensitive to insulin. A 1989 study of persons with pancreatitis-caused diabetes also seems to point to the same effect in humans, noting that those in the study had low glucagon levels which did not respond normally. The lack of normal glucagon action, which raises blood glucose levels, appears to indicate problems with the way the body responds to hypoglycemia. It goes on to mention that their epinephrine responses to insulin-related hypoglycemia is also abnormal. With epinephrine aka adrenalin acting counter to insulin by raising blood glucose levels, this would seem to further signal problems with the way the body is able to respond to hypoglycemia for those with pancreatitis and diabetes. Another human-based study suggests that there is a correlation between the endocrine pancreas associated with diabetes and the function of the exocrine pancreas associated with pancreatitis. Insulin-dependent diabetics were rated as having the most severe exocrine pancreas deficit. Those who were able to control their diabetes with oral medications in the sulphonylurea class were deemed as having intermediate exocrine pancreas deficit. Those who were able to control their diabetes with oral medications of the biguanide class--with or without the help of diet alteration and those who are diet-controlled without any medications, were considered to be free from exocrine pancreas deficit. Dogs with Cushing's disease and hypothyroidism are also at an increased risk for acute episodes of pancreatitis. Causes Pancreatitis in Dogs. Some possible causes of pancreatitis: * Obesity/Overweight: This is true for many dogs diangosed with pancreatitis. It is also more likely to develop when a high-fat diet is being fed. * Hyperlipidemia:or high fat content in the blood. The levels of fat in the blood often rise after eating, but for those without hyperlipidemia, this is a temporary state. Metabolic problems in both pets and people can prevent the removal of fat from the blood. Some studies show that hyperlipidemia can be a cause of pancreatitis. A low-fat or restricted fat diet is suggested for all diabetic dogs, as it may prevent pancreatitis. Beyond Insulin Therapy: Achieving Optimal Control in Diabetic Dogs Drs. Fleeman & Rand-U-Queensland 2005 * Infections--from either viruses (viral) or bacteria (bacterial) can cause pancreatitis in dogs. * Injury: An injury or trauma to the abdominal area can result in injury to the pancreas; this can mean possible pancreatitis. Diagnosis Pancreatitis is often hard to diagnose; sometimes it's arrived at by ruling out other GI problems. Tests include the serum TLI (Trypsin-Like Immunoreactivity), and the canine PLI (Pancreatic Lipase Immunoreactivity), available from the gastrointestinal laboratory at the College of Veterinary Medicine at Texas A&M University. Turnaround from that lab often takes several days. A canine-specific PLI test is also commercially available through IDEXX Laboratories as the Spec cPL™ Test. Ultrasound is also often helpful in the dianosis process. Labwork for dogs has more clear-cut signs of abnormal values than the results can for cats. Some cats have normal lab results and also have pancreatitis. Rare but possible It doesn't happen frequently, but it is possible for a pancreatitis attack to "jolt" the endocrine portion of the organ back into being capable of producing insulin once again in dogs. Treatment It may be very tricky to treat, also. It can cause insulin resistance, dehydration, and also nausea and vomiting, all of which complicate diabetes. Pets can also begin drinking more water. For the most part, they also commonly show a higher than normal temperature when the disease is in its beginning stages. As pancreatitis progresses, the body temperature may go below normal. Hills Pet Products-Owner's Guide to Pet Care-Pancreatitis Some recommended treatments to ask your vet about include: *Change in diet to a low-fat food. * "resting" the pancreas by withholding all food, water and oral medications for a short time frame. Subcutaneous fluids bypass the oral route; in avoiding the oral route, the pancreas is also avoided. Medical term for this is "nil per os", , or "nothing by mouth" * pancreatic enzymes to compensate for pancreatic insufficiency, but only when indicated by the TLI. * Subcutaneous fluids to combat dehydration. These can be given at home. Complications of Pancreatitis Chronic pancreatitis can lead to maldigestion syndrome in which the pancreas fails to produce enough digestive enzymes. A severe attack is capable of damaging the exocrine pancreas, which produces the digestive enzymes and the endocrine pancreas, which produces insulin. Having a severe attack also puts one at risk for developing chronic pancreatitis. Pancreatitis can also be serious enough to affect the endocrine portion of the pancreas, in some cases causing a temporary or transient diabetes. In others, the damage to the insulin-producing beta cells is severe enough to make them permanently unable to function; the diabetes is permanent. Here's help-message boards and e-mail lists *Pancreatitis in Dogs Discussion Group References More Information * Canine Diabetes with rebound hyperglycemia Richards, Mike, VetInfo4Dogs Details about how diabetes with pancreatitis can be difficult, at first. Also details how (rarely!) a canine with pancreatitis and diabetes can begin producing insulin again. *Can You Rule Out Pancreatitis? Hoskins, Johnny D., 2002, DVM News Charts, ultrasound photos and a good review of pancreatitis, with a special section for older dogs. *Pancreatitis in Dogs Drs. Foster & Smith *Acute Pancreatitis in Dogs PetPlace *Subclinical Pancreatitis is More Common in Overweight and Obese Dogs if Peak Postprandial Triglyceridemia is >445 mg/dl-page 51, Abstract #336 ACVIM 2008, Posters *Continuing Pancreatic Inflammation or Reduced Exocrine Function Are Common in Dogs After Acute Pancreatitis-Abstract #143, Page51 ACVIM Abstracts, 2006 *Canine Pancreatitis From Clinical Suspicion to Diagnosis and Treatment Spillmann, Thomas, 2008, WSAVA * Discussion about PLI tests Antech Diagnostics * Development and analytic validation of an enzyme-linked immunosorbent assay for the measurement of canine pancreatic lipase immunoreactivity in serum Jörg M. Steiner, Sheila R. Teague, David A. Williams, 2003, Canadian Journal of Veterinary Research Discussion about PLI tests. *Explaining the Differences in Pancreatitis in Dogs & Cats *Pancreatitis in Dogs & Cats Burrows, Colin, 2002, WSAVA *Risk Factors for Pancreatitis in Dogs & Cats Provet UK *The Perils of Acute Pancreatitis in the Dog and Cat Schaer, Michael, 2005, WSAVA *Lots of good pancreatitis links for cats and dogs *Treatment Options for Canine Pancreatitis Idexx *Diagnosing and Treating Pancreatitis an IDEXX Roundtable Discussion *Diagnosing Pancreatitis Southpaws *Pancreatitis North American Veterinary Conference *Diagnosis and Management of Acute Pancreatitis in the Dog and Cat Simpson, Kenneth W., October 2000, District of Columbia Academy of Veterinary Medicine *Diagnosing Pancreatitis in Dogs and Cats by Laboratory Methods West. Laura D., et. al., 2007, University of Georgia *Pancreatitis: Lessons from the Human Model Veterinary Clinics of North America *Chronic Pancreatitis in Dogs: More Common than you Think North American Veterinary Conference *Nutritional Management of the Most Common Digestive Diseases in Dogs and Cats Carciofi, Aulus Cavalieri, 2009, WSAVA *Pain in Pancreatitis? Not necessarily North American Veterinary Conference 2006 *Investigating the Cause of Chronic Vomiting VetCentric *Vetsulin-Diabetes-Related Diseases Intervet *How I Diagnose/Treat Chronic Pancreatitis in Dogs Steiner, Jörg M., 2010, WSAVA *Helpful Laboratory Tests in the Diagnosis of Gastrointestinal Disorders Steiner, Jörg M., 2010, WSAVA Category:Infections Category:Complications Category:Other conditions and procedures Category:Gastrointestinal Disorders Category:Content Category:Conditions